Your long term disability benefits have been approved. Now what? Unfortunately, an approval of benefits by disability insurance companies does not guarantee continued benefit payments. The insurer will periodically monitor your claim to ensure you continue to satisfy the definition of disability under the terms of the policy. During this time period, the disability insurance company will request and review updated information regarding your claim.
The disability attorneys at Riemer Hess will take the burden off your shoulders by preparing the requested updates and performing due diligence to ensure that the information is complete and not subject to misinterpretation by the insurer. We assist hundreds of professional and executive clients each month with requests for updates, interviews, and medical examinations from all the major disability insurance companies.
Why Do I Need to Submit Updated Information to the Disability Insurance Company?
The policy contains provisions, which place the burden of proving disability on you, and not the disability insurance companies. These provisions are applicable even after the insurer has deemed you to be disabled. Failure to furnish requested update information could result in the termination of your benefits. A typical provision provides, “Proof of continued disability and regular attendance of a physician must be given to the Company within [X] days of the request for the proof.”
What Type of Information will the Insurer Request?
The insurer’s request for an update will be similar to the forms and supporting documents, which were submitted with your application for benefits. Our disability attorneys will not need to begin from scratch and will work with you and your treating physician(s) to obtain the updated information requested by the insurer in a streamlined process.
The disability insurance company will request updated information regarding your condition(s), continued treatment, activities of daily living, financial status, and whether you have attempted to work and/or volunteer, if applicable. Examples of commonly requested types of updates include:
- A physician’s statement;
- Updated medical records;
- A statement from you; and/or
- Financial documents, such as tax returns and paystubs.
The insurer’s request for updates, however, is not limited to forms and supporting documents. The policy typically contains a provision, which permits the disability insurance companies to request the following:
- An In-Person or Telephone Interview with the Insurer’s Representative; and/or
- A Medical Examination by a Physician Retained by the Insurer.
A typical provision provides, “We can require examinations as often as it is reasonable to do so. We may also require you to be interviewed by an authorized [INSURER] Representative. Refusal to be examined or interviewed may result in denial or termination of your claim.”
Our disability attorneys understand that undergoing an interview and/or medical examination requested by the disability insurance companies is stressful. We will meet with you prior to the appointment date to discuss what to expect and answer any questions you may have regarding the interview and/or examination.
Can My Treating Physician Contact the Insurer Directly to Provide Updates?
All communications with the insurer should be in written form to ensure that what is being conveyed to the disability insurance company is accurately documented and included in your claim file. We ask the insurer to direct all requests to your physician to our firm in written form so that we in turn can forward the request to your physician. This permits us to control the flow of information and minimize the ability of the insurance company to misrepresent the opinion of your doctor.
How Much Time Do I have to Respond to the Insurer’s Request?
The letter detailing the insurer’s request for updated information will include the due date. The deadline to submit your updates is typically 30 days, but the deadline varies from insurer to insurer.
There are sometimes factors that are beyond our disability attorneys’ control (e.g., delayed response from physician’s office), which will require us to obtain an extension from the insurer. We will inform the insurer why the updates cannot be timely submitted. This is important because an untimely submission may be interpreted by the insurer as non-compliance, and could result in a termination of benefits.
How Often will the Insurer Monitor my Claim?
The insurer will monitor your claim on a periodic basis (e.g., yearly, semi-annually, quarterly, or monthly). Insurers typically review newly approved claims on a monthly basis, but may reduce the frequency down the road. Insurers, however, occasionally require less monitoring where the evidence supports no potential for medical improvement. The disability insurance companies will refer these claims to an internal department dedicated to handling “stable and mature” claims.